机器人辅助部分肾切除术转为根治性肾切除术：一项前瞻性多机构研究。

Conversion of Robot-assisted Partial Nephrectomy to Radical Nephrectomy: A Prospective Multi-institutional Study.

作者信息

Arora Sohrab, Chun Brian, Ahlawat Rajesh K, Abaza Ronney, Adshead James, Porter James R, Challacombe Benjamin, Dasgupta Prokar, Gandaglia Giorgio, Moon Daniel A, Yuvaraja Thyavihally B, Capitanio Umberto, Larcher Alessandro, Porpiglia Francesco, Mottrie Alexander, Bhandari Mahendra, Rogers Craig

机构信息

Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI.

出版信息

Urology. 2018 Mar;113:85-90. doi: 10.1016/j.urology.2017.11.046. Epub 2017 Dec 25.

DOI:10.1016/j.urology.2017.11.046

PMID:29284123

Abstract

OBJECTIVE

To assess the incidence and factors affecting conversion from robot-assisted partial nephrectomy (RAPN) to radical nephrectomy.

METHODS

Between November 2014 and February 2017, 501 patients underwent attempted RAPN by 22 surgeons at 14 centers in 9 countries within the Vattikuti Collaborative Quality Initiative database. Patients were permanently logged for RAPN prior to surgery and were analyzed on an intention-to-treat basis. Multivariable logistic regression with backward stepwise selection of variables was done to assess the factors associated with conversion to radical nephrectomy.

RESULTS

Overall conversion rate was 25 of 501 (5%). Patients converted to radical nephrectomy were older (median age [interquartile range] 66.0 [61.0-74.0] vs 59.0 [50.0-68.0], P = .012), had higher body mass index (BMI) (median 32.8 [24.9-40.9] vs 27.8 [24.6-31.5] kg/m, P = .031), higher age-adjusted Charlson comorbidity score (median 6.0 [4.0-7.0] vs 4.0 [3.0-5.0], P <.001), higher American Society of Anesthesiologists score (score ≥3; 13/25 (52.0%) vs 130/476 (27.3%), P = .021), Preoperative estimated glomerular filtration rate (P = .141), clinical tumor stage (P = .145), tumor location (P = .140), multifocality (P = .483), and RENAL (radius, exophytic/endophytic properties, nearness of tumor to the collecting system or sinus in millimeters, and anterior/posterior location relative to polar lines) nephrometry score (P = .125) were not significantly different between the groups. On multivariable analysis, independent predictors for conversion were BMI (odds ratio [95% confidence interval]; 1.070 [1.018-1.124]; P = .007) and Charlson score (odds ratio [95% confidence interval]; 1.459 [1.179-1.806]; P = .001).

CONCLUSION

RAPN was associated with a low rate of conversion. Independent predictors of conversion were BMI and Charlson score. Tumor factors such as clinical stage, location, multifocality, or RENAL score were not associated with increased risk of conversion.

摘要

目的

评估机器人辅助部分肾切除术（RAPN）转为根治性肾切除术的发生率及影响因素。

方法

在2014年11月至2017年2月期间，9个国家14个中心的22名外科医生在Vattikuti协作质量倡议数据库中对501例患者尝试进行RAPN。患者在手术前被永久记录为RAPN，并按意向性治疗原则进行分析。采用多变量逻辑回归并进行变量的向后逐步选择，以评估与转为根治性肾切除术相关的因素。

结果

总体转化率为501例中的25例（5%）。转为根治性肾切除术的患者年龄较大（中位年龄[四分位间距]66.0[61.0 - 74.0]岁对59.0[50.0 - 68.0]岁，P = 0.012），体重指数（BMI）较高（中位值32.8[24.9 - 40.9]对27.8[24.6 - 31.5]kg/m²，P = 0.031），年龄校正的Charlson合并症评分较高（中位值6.0[4.0 - 7.0]对4.0[3.0 - 5.0]，P < 0.001），美国麻醉医师协会评分较高（评分≥3；13/25（52.0%）对130/476（27.3%），P = 0.021），术前估计肾小球滤过率（P = 0.141）、临床肿瘤分期（P = 0.145）、肿瘤位置（P = 0.140）、多灶性（P = 0.483）以及RENAL（半径、外生性/内生性特征、肿瘤与集合系统或肾窦的距离（以毫米为单位）以及相对于极线的前后位置）肾计量评分（P = 0.125）在两组之间无显著差异。多变量分析显示，转为根治性肾切除术的独立预测因素为BMI（比值比[95%置信区间]；1.070[1.018 - 1.124]；P = 0.007）和Charlson评分（比值比[95%置信区间]；1.459[1.179 - 1.806]；P = 0.001）。